Multiple sclerosisWednesday, May 31, 2006, 08:30 - 10:00
Alemtuzumab and craniotomy for severe acute demyelinating illnessK.M. Gormley, J.P. Zajicek (Plymouth, GB)
A 37-year-old female in the immediate puerperal period presented with an acute severe demyelinating illness, which did not respond to high doses of intravenous steroids, immunoglobulin or plasma exchange. In keeping with a Marburg variant or tumefactive demyelinating disease, the clinical course indicated a space demanding process as well as a demyelinating one. At her worst, the patient was aphasic and unable to move any limb. Failure of conventional therapy necessitated decompressive craniotomy to alleviate brainstem compression as a neurosurgical emergency, at which point a biopsy was also performed. This was followed by intravenous alemtuzumab. From a virtually moribund condition, the patient improved to the point of returning to her normal life, with minimal language problems.
Although emergency craniotomy has been reported once before in this situation, this is the first time such a successful combined neurosurgical and medical approach has been reported to treat malignant demyelinating disease, with good results up to 12 months after initial presentation.